JP2017501826A - Instruments for attaching bone plates - Google Patents

Abstract

A wire insertion device for attaching a bone plate to bone is used in the method, the method comprising: placing the first surface of the wire insertion device (4) in contact with the bone; and the first surface of the wire insertion device. Inserting a reference wire (5) through an opening (16) of the wire insertion instrument extending through to a second surface of the wire insertion instrument, removing the wire insertion instrument from the reference wire, Positioning the bone plate (8) on the bone by moving the bone plate in a direction transverse to the longitudinal axis of the reference wire so that the bone plate is received in the slot (36) of the bone plate, The plate includes a first surface (39) facing the bone and a second surface (38) opposite the first surface, the slot being open to the outer surface (35), the first and Second Connecting the edges of the surface, and a step of positioning.

Description

  The present invention relates to the field of surgical methods and surgical instruments / instruments, and more particularly, to a method for attaching a bone plate to bone, an instrument / instrument used in the method and a bone fixation kit. Specifically, the invention relates to a method for attaching a bone plate to a human proximal femur.

  In the method of attaching the bone plate to the bone, the affected area is opened, the fracture is reduced, the bone plate is usually placed in contact with the bone, and fixed to the bone by a suitable bone anchor such as a bone screw, nail, pin, etc . However, prior to fixation of the bone plate, it is necessary to achieve accurate alignment of the bone plate. In particular, the positioning and alignment of the bone anchor is important to ensure a good healing process. Thus, methods of attaching a bone plate often utilize a reference wire that is inserted into the bone through a hole in the bone plate, eg, using a drill sleeve. The reference wire may be, for example, a K-wire (Kirschner steel wire). The reference wire is inserted into the bone through the hole in the bone plate in the correct orientation and is used to guide the first bone anchor over it. Thus, the first bone anchor may be cannulated for this purpose. Once the first bone anchor is in place, additional bone anchors are inserted into the bone through corresponding through holes in the bone plate depending on the application. In particular, in the case of large bone plates for long bones such as, for example, the femur or tibia, the implantation and correct alignment and positioning of the bone plate can be difficult and difficult.

  It is an object of the present invention to provide a method for properly attaching a bone plate to bone and a corresponding bone fixation kit that facilitates proper attachment of the bone plate to the bone.

  According to a first aspect of the present invention, a method for attaching a bone plate to bone includes the step of placing a first surface of a wire insertion device in contact with the bone. The wire insertion instrument preferably includes a base with a first side configured to be placed against the bone in a defined manner and a second side opposite the first side.

  In one exemplary embodiment, the opening extends through the base of the wire insertion instrument from the first side to the second side. The opening may be sized and shaped to receive the reference wire and guide the reference wire in a defined direction. Preferably, the wire insertion instrument includes a handle or leg extending away from the first side. This facilitates handling of the wire insertion instrument.

  The reference wire is guided into the opening of the wire insertion instrument and into the bone. The surface of the wire insertion instrument coincides with the surface of the bone to be positioned in contact so that the bone plate can be placed in contact with the bone in a defined manner. The opening of the wire insertion instrument is aligned to a length selected to be sufficient for accurate guidance and to the desired orientation of the reference wire. Thus, the reference wire can be accurately inserted into the bone.

  In the next step, the wire insertion instrument may be removed from the reference wire inserted into the bone. The wire insertion instrument may be withdrawn from the bone along the longitudinal extension of the reference wire.

  In an exemplary embodiment, the wire insertion instrument is first removed and then the bone plate is positioned on the bone. The bone plate may include a slot that is open toward an outer surface that connects the first bone-facing surface of the bone plate and the second surface of the bone plate opposite the first surface. . The bone plate may be positioned along the bone by moving the bone plate transversely to the longitudinal axis of the wire until the reference wire is received within the slot of the bone plate.

  The exemplary method facilitates positioning the bone plate on the bone because the reference wire is inserted into the bone prior to the actual positioning of the bone plate. The bone plate itself is only advanced to the bone in the next step. The slot in the bone plate allows the bone plate to be advanced to a reference wire that has already been inserted into the bone. In a preferred embodiment, the bone plate is moved laterally, i.e. across the longitudinal axis of the reference wire. The bone plate may be inserted into the affected area and positioned with respect to the reference wire through the skin incision, and unlike a hole that is closed around the circumference, the slot is inserted into the body after the bone plate is inserted into the body. Allows the plate to advance to the reference wire. In other words, because the slot is open, the bone plate can be advanced into the body without having to slide along the wire through the incision until the wire reaches the bone plate; It can be manipulated until the slot is adjacent to the site of entry of the wire into the bone. The plate can then be slid so that the wire enters the slot. Since the wire insertion instrument has a smaller size than the bone plate and can be more easily inserted into the affected area and placed in contact with the bone, using a separate wire insertion instrument to insert a reference wire into the bone In addition, the method is simplified.

  In an exemplary embodiment, the surface of the wire insertion instrument that is configured to be placed against the bone has a surface shape that corresponds to the shape of the bone surface. According to one exemplary embodiment, the wire insertion instrument is configured to be placed against the greater trochanter of a human proximal femur, particularly the proximal femur. In order to prevent slipping off the surface of the bone, or at least to reduce such slipping, the surface of the wire insertion instrument configured to be placed against the bone may include at least one mandrel protruding from the surface. Good. It will be appreciated that other surface structures may be provided to reduce or prevent slip, such as ribs, teeth, cusps or other protrusions.

  To further facilitate handling, the wire insertion instrument may include a handle. In an exemplary embodiment, the wire insertion instrument may include a leg that extends from the instrument, and includes a handle connection that allows a removable hand grip to be fastened to the end thereof.

  According to an exemplary embodiment, the method includes mounting a positioning device or aiming or guiding block on the bone plate prior to positioning the bone plate on the bone. The bone plate is then positioned on the bone by a positioning instrument mounted on the bone plate. The positioning device may include a base having a first surface configured to be placed against the bone plate in a defined manner and a second surface opposite the first surface. In order to facilitate aligning and mounting the positioning device to the bone plate, the shape of the surface of the positioning device facing the bone plate may correspond to the shape of the second surface of the bone plate. In one exemplary embodiment, the positioning device is positioned against and aligned with the bone plate before being secured to the bone plate.

  According to an exemplary embodiment, the positioning instrument includes a slot extending through the instrument between the first and second surfaces of the instrument base and open to the outer surface of the base. When the positioning device is mounted on the bone plate, the slot of the positioning device can be aligned with the slot of the bone plate. This allows the reference wire to engage both the slot of the bone plate and the slot of the positioning instrument once the bone plate is positioned on the bone. Thus, alignment and positioning of the bone plate on the bone is further improved because the positioning device also engages the reference wire.

  According to an exemplary embodiment, the protective sleeve includes a first axial passage and a second axial passage that is parallel thereto. Accordingly, the sleeve is designated as a double sleeve. A sleeve having first and second axial passages may be inserted into a slot in the positioning instrument and into a through-hole that opens through the slot to the surface of the outer surface. Thus, the sleeve may be guided along the reference wire via its first axial passage. After the bone plate has been advanced to the reference wire, the sleeve may be guided through the reference wire. However, before the bone plate is moved to the desired position along the bone with respect to the reference wire, the sleeve is partially guided along the reference wire so that the sleeve is received in the slot and through holes of the positioning device. It will be appreciated by those skilled in the art that once the plate is moved to the desired position, it can be pushed further in the direction of the bone.

  The sleeve also functions as a drill sleeve. Tools for drilling bone, such as a drill bit of a dril, ram, K-wire, etc., may be inserted into the second axial passage of the sleeve. By providing a sleeve having two axial passages, one of the axial passages is configured to receive a reference wire while the other axial passage is configured to receive at least one tool. So the method is simplified. Thus, special items such as cannulated bone anchors are not necessary.

  As the bone is drilled through the second axial passage, the bone anchor may be inserted into the bone through the positioning tool through hole and through the bone plate through hole. Preferably this is the first bone anchor, whereby the bone plate is fixed on the bone. The first bone anchor is critical because it provides a reference for further bone anchors.

  According to a further exemplary embodiment, a flexible ruler or measuring instrument is provided that can be coupled to a sleeve or other drill sleeve. When a drilling tool such as a drill, which can have a diameter that is significantly larger than the diameter of the drill bit and / or the drill sleeve, is inserted, the flexible measuring instrument is the first of the drill sleeve, especially the double sleeve. The two axial passages can bend away from the longitudinal axis. This makes it easy to measure the depth of the hole in the bone, since it is not necessary to remove the drilling tool to measure the depth of the hole. A flexible measuring instrument can be bent away from the longitudinal axis of the sleeve so it can remain mounted on the sleeve.

  A sighting instrument is used to insert additional bone anchors. The aiming instrument is configured to guide at least one drill sleeve for targeting and drilling in the bone. In particular, the aiming instrument includes a first surface and a second surface opposite the first surface, a first surface and a second surface sized and shaped to receive at least one drill sleeve. With a through hole extending through the aiming instrument therebetween. In an exemplary embodiment, the aiming instrument can be implemented on the positioning instrument. In particular, the aiming device may be connected to a handle connection of a positioning device in which a hand grip is also mounted. The aiming instrument may be positioned relative to the bone plate by a positioning instrument.

  According to a further exemplary embodiment, the orientation wire is inserted into the bone before the wire insertion instrument is placed against the bone. When the orientation wire is inserted into the bone, the wire insertion instrument is placed in the bone so that the reference wire inserted by the wire insertion instrument is placed in a plane parallel to the plane on which the previously inserted orientation wire is placed. You may arrange | position so that it may touch. An orientation wire may be inserted into the bone under the control of the imaging technique. The orientation wire is used to help determine the correct orientation of the reference wire relative to the wire insertion instrument. For example, the orientation wire may be inserted into the femur parallel to the femoral neck. Next, a reference wire is inserted in a plane that is parallel in side view to the plane on which the orientation wire is placed. In this way, correct alignment of the reference wire is ensured. Once the reference wire is in place, the orientation wire may be removed. The reference wire is preferably inserted through the center of the femoral neck.

  According to a further aspect of the invention, the bone fixation kit includes the described wire insertion instrument, bone plate, and positioning instrument. The bone fixation kit also includes at least one reference wire and at least one sleeve, preferably the double sleeve described above. In addition, the bone fixation kit may include the flexible measuring instrument and aiming instrument described.

The foregoing summary, as well as the following description of exemplary embodiments, will be better understood when read in light of the appended drawings. Exemplary embodiments of the invention are described below with reference to the accompanying drawings. However, it will be understood that the application is not limited to the illustrated exemplary embodiments. The drawings are as follows.
Fig. 4 illustrates steps of an exemplary method for attaching a bone plate to bone. Fig. 4 illustrates steps of an exemplary method for attaching a bone plate to bone. Fig. 4 illustrates steps of an exemplary method for attaching a bone plate to bone. Fig. 4 illustrates steps of an exemplary method for attaching a bone plate to bone. Fig. 4 illustrates steps of an exemplary method for attaching a bone plate to bone. Fig. 4 illustrates steps of an exemplary method for attaching a bone plate to bone. Fig. 4 illustrates steps of an exemplary method for attaching a bone plate to bone. Fig. 4 illustrates steps of an exemplary method for attaching a bone plate to bone. Fig. 4 illustrates steps of an exemplary method for attaching a bone plate to bone. FIG. 3 shows a perspective view of a wire insertion instrument according to an exemplary embodiment of the present invention. FIG. 11 shows a side view of the wire insertion instrument of FIG. 10. FIG. 11 shows another side view of the wire insertion instrument of FIG. 10. FIG. 11 shows a cross-sectional view of the wire insertion instrument of FIG. 10. FIG. 3 shows a perspective view of a positioning device according to an exemplary embodiment of the present invention. Figure 15 shows a side view of the positioning device of Figure 14; Fig. 15 shows a plan view of the positioning device of Fig. 14; FIG. 4 shows a top view of a portion of a bone plate according to an exemplary embodiment of the present invention. FIG. 18 shows a side view of the bone plate of FIG. 17 with the reference wire shown. FIG. 3 shows a perspective view of a double sleeve according to an exemplary embodiment of the present invention. 2 shows a meter according to an exemplary embodiment of the present invention.

  A more complete understanding of the present invention may be obtained by reference to the following description and the accompanying drawings. In the drawings, similar elements are denoted by the same reference numerals. The present invention is directed to a system and method for the treatment of bone. Specifically, exemplary embodiments of the present invention describe systems and methods for securing a bone plate to bone. Although exemplary embodiments are specifically described with respect to a proximal femur, those of skill in the art will appreciate that the systems and methods of this embodiment can be utilized with any of a variety of bones, particularly long bones. Will.

  1-9 show the steps of a method for attaching a bone plate to bone. In the exemplary embodiment, the bone plate 8 is attached to the region of the human proximal femur 1, in particular the greater trochanter part 2. According to an exemplary embodiment of the method, the affected area may first be positioned on the operating table. Using the template, the length of the bone plate that is fixed to the femur 2 may be determined in the X-ray image of the leg. For example, the template may be placed on the skin so as to overlap the underlying bone of the X-ray image and the length of the bone plate to be implanted may be determined.

  To expose the fracture site, after opening the affected area, i.e. after the corresponding incision has been made, the fracture is reduced using known methods. For example, the fracture may be reduced with a Shants screw, a fracture, particularly a forceps for compressing the fracture site of the bone separated by a bone gap, or other suitable instrument. In order to check the correct alignment of the bone, in particular the forward tilt, the orientation wire 3 is first inserted into the bone. An orientation wire may be inserted into the bone under the control of the imaging technique. The orientation wire 3 may be inserted into the bone using, for example, an imaging technique. FIG. 1 shows an orientation wire 3 inserted into the bone. The orientation wire 3 can be inserted into the femur through the incision or percutaneously. The orientation wire 3 may be inserted into the femoral head of the bone along an axis that is parallel to the axis of the femoral neck. The orientation wire 3 functions as an orientation aid for the reference wire 5 inserted into the bone.

  As shown in FIG. 2, in the next step of the method, the wire insertion instrument 4 is placed in contact with the femur 1, in particular in contact with the greater trochanter 2. The wire insertion instrument 4 may include a surface shaped to coincide with the surface of the femur 1, in particular the greater trochanter 2. Due to the relatively small dimensions, in particular due to the relatively small dimensions compared to the bone plate, the wire insertion instrument 4 can be arranged to easily touch the bone 1 through the incision. The surgeon can guide and hold the wire insertion instrument 4 by the handgrip 9 fastened to the leg 13 of the wire insertion instrument 4.

  In the next step, as shown in FIG. 3, the reference wire 5 is inserted into the femur 1 through the opening of the wire insertion instrument 4. In an exemplary embodiment of the method, the reference wire 5 may be inserted through the center of the femoral head. In FIG. 4, the orientation wire 3 and the reference wire 5 are represented by the positions inserted in the femur 1. The orientation wire 3 and the reference wire 5 are located on two surfaces that are parallel to each other in the side view of the femur 1. As shown in FIG. 19, the protective sleeve 6 having the first axial passage 41 and the second axial passage 40 is connected to the reference wire via the first axial passage 41 as shown in FIG. 5 is guided along.

  As shown in FIGS. 6-8, the reference wire 5 is used for alignment and positioning of the bone plate 8. In particular, as seen in FIG. 6, the bone plate 8 is inserted into the affected area via a positioning or aiming instrument 7. For this purpose, the positioning device 7 is preferably already connected to the bone plate 8 before the incision is made. FIG. 6 shows a snapshot during operation in which the bone plate 8 is inserted via the positioning device 7. The bone plate 8 and the positioning device 7 are inserted through the incision with respect to the reference wire 5. As shown in FIG. 7, the bone plate 8 and the positioning device 7 may be moved laterally with respect to the longitudinal direction of the reference wire 5. In particular, advancement of the bone plate 8 to the reference wire 5 is achieved along the femur 1 in the direction from proximal to distal. As described in detail below, the bone plate 8 and the positioning device 7 each have a slot at the proximal end for this purpose. In other words, the bone plate 8 and the positioning device 7 are inserted through the incision and moved distally along the bone 1 until the slot at the proximal end of the bone plate 8 and the positioning device 7 receives the reference wire 5.

  For example, the sleeve 6 engages the positioning device 7 when the bone plate 8 is positioned over the desired portion of the bone with the reference wire 5 received in the slot at the proximal end of the bone plate 8. Pushed forward until. As shown in FIG. 8, a corresponding tool 12 for drilling is inserted through the second axial passage 40 of the sleeve 6 to drill a hole in the bone to receive a bone anchor. May be. This is particularly useful for inserting a first bone anchor to secure the bone plate 8 to the bone 1 through a slot at the proximal end of the bone plate 8. The tool 12 may be, for example, a drill bit, a ram, a Kirschner steel wire (K-wire), a trocar, or the like. Once the first bone anchor is in place, the sleeve 6, the reference wire 5 and, if any, the orientation wire 3 can be removed. It will be appreciated by those skilled in the art that the orientation wire 3 may have already been removed after the reference wire 5 has been placed.

  Next, as represented in FIG. 9, the positioning device 7 is connected to a sighting device 10 that is used to focus in the bone 1 and drill further. One or more protective sleeves 11 may be guided through the aiming instrument 10 at different angles. To place a bone anchor in the femoral neck, a drill sleeve is inserted through the protective sleeve 11 and a drill bit is guided therethrough to drill through the proximal head of the bone plate 8. Good. Similarly, the protective sleeve is also lowered at the distal shaft portion of the bone plate 8 so that the corresponding bone anchor can be inserted into the underlying bone 1 via the distal shaft portion of the bone plate 8. In order to drill a hole in a bone 1, it may be guided through a sighting instrument 10.

  10-12 show views of different aspects of the wire insertion instrument 4, and FIG. 13 shows a cross-sectional view thereof. The wire insertion instrument 4 includes a base 12 having a surface 14 configured to be placed against the greater trochanter 2 of the bone 1 and a surface or side 15 opposite the surface 14. From the side 15 not facing the bone, the leg 13 extends at its free end with a handle connection 17. For example, as can be seen in FIGS. 2 and 3, a removable hand grip 9 may be fastened to the handle connection 17. The hand grip 9 is removable from the wire insertion instrument 4 and is sterilized separately from the instrument. In order to prevent or prevent the wire insertion instrument 4 from sliding against the bone, in one exemplary embodiment, the surface 14 may be shaped, for example, shaped to be placed against the bone 1. Three mandrels 18 may be included for engaging the bone surface. The mandrel 18 may be, for example, a protrusion extending from the surface 14 and includes a sharp tip for engaging the bone surface. Although the exemplary embodiment is specifically illustrated and described with three mandrels 18, fewer or greater numbers of mandrels or other suitable structures may be provided without departing from the scope of the present invention. It will be understood that it may be.

  As seen particularly in the cross-sectional view of FIG. 13, the opening 16 extends through the base 12 from the surface 14 to the opposite side 15. The opening 16 is sized and shaped to guide the reference wire 5. In order to facilitate the insertion of the reference wire 5, the opening 16 may be chamfered at the end facing the side 15. The length of the opening 16 is selected to be sufficient to guide the reference wire 5. The diameter of the opening 16 is also selected as such. For example, the inner diameter of the opening 16 may correspond to the outer diameter of the reference wire 5. The diameter of the opening 16 may be in the range of 2 to 15 mm, for example. The axial length of the opening 16 may be in the range of 5 to 50 mm, for example.

  According to other embodiments (not shown), the opening 16 may be configured as a transverse slot that opens to the surface of the outer surface of the base 12, so that the wire insertion instrument 4 is longitudinal in the reference wire 5. It is possible to move away from the reference wire 5 in a direction transverse to the axis. In this embodiment, the opening 16 may be similar to the design of the positioning device 7 described in more detail below. In this embodiment, the sleeve 6 is preferably used for inserting the reference wire 5.

  14-16, different aspects of the positioning device 7 are represented. The positioning device 7 includes a base 22 with a lower surface 24 configured to be placed against the bone plate 8. For example, the lower surface 24 may be formed so as to include a curved portion corresponding to the curved portion of the bone plate 8. Legs 23 extend from an upper surface 25 opposite the surface 24. The leg 23 has at its free end a connection 27 that may be used to fasten the handgrip 9 described above, particularly with respect to the wire insertion instrument 4 shown in FIGS. The connection 27 may also be used to fasten the aiming device 10 specifically represented in FIG. The aiming instrument 10 may be connected to the connecting portion 27 by, for example, a knurled head screw 19. One skilled in the art will appreciate that other suitable fastening mechanisms may be provided in place of the knurled head screw 19. In an exemplary embodiment, the coupling 27 is formed so that the aiming instrument 10 can be attached to the aiming instrument 10 in only one orientation to ensure the desired alignment of the aiming instrument 10 with respect to the bone plate 8. The The positioning device 7 may be fastened to the bone plate 8, for example by screws 28, preferably before the affected part is opened. It will be appreciated by those skilled in the art that the positioning device 7 may also be coupled to the bone plate 8 by a snap connection, bayonet lock, or any other suitable fixation configuration instead of the screw 28. . In another embodiment, the positioning device 7 may stop against the bone plate 8 in proper alignment with the corresponding features of the positioning device 7 and the bone plate 8. In particular, the lower surface 24 extends from the lower surface and has a plurality of protrusions (eg, ball-shaped) that are sized and shaped to be received in corresponding openings extending through the surface of the bone plate 8. May be included. The ball ensures that the positioning device 7 is properly aligned with the bone plate 8.

  The positioning device 7 extends through the base 22 between the surface 24 and the surface 25 and has a through hole 21 opened by a slot 26 on the surface of the outer surface extending between the surface 24 and the surface 25. including. In the illustrated embodiment, the slot 26 and the through hole 21 are interconnected. The slot 26 and the through hole 21 are sized and shaped to receive the sleeve 6. In particular, the first axial passage 41 of the sleeve 6 is received in the slot 26, while the second axial passage 40 of the sleeve 6 is received in the through hole 21.

  The first axial passage 41 of the sleeve 6 has a smaller diameter than the second axial passage 40 of the sleeve 6. The first axial passage 41 serves only to receive the reference wire 5, while the second axial passage 40 receives a tool, such as a drill bit 42, described in more detail below. It is made in such a size and shape. The drill bit 42 may be guided into the bone through the second axial passage 40 to puncture the bone. Accordingly, the second axial passage 40 may have a diameter that is greater than the diameter of the first axial passage 41.

  17 and 18 show a portion of the bone plate 8 configured to be placed against the greater trochanter 2. The bone plate 8 includes a head portion 34 and a shaft portion 33. The head 34 may have a curvature corresponding to the curvature of the greater trochanter 2. The bone plate 8 may include through holes 30, 31, 32 that extend through the bone plate 8 from the bone-facing surface 39 of the bone plate to the non-bone-facing surface 38. The through hole 30 extends through the shaft portion 33 of the bone plate 8 and includes a portion for fixing the variable angle of the head set screw and a compression hole for receiving a bone anchor having a smooth screw head. Formed as a combination hole having portions. The through holes 31, 32 extend through the head 34 of the bone plate 8 and are preferably formed as variable angle lock holes.

  The bone plate 8 further includes a slot 36 that extends through the head 34 from a bone-facing surface 39 to a non-bone-facing surface 38, the slot facing the bone-facing surface 39 and the non-bone-facing surface 38. It is open on the surface 35 of the outer surface connecting the edges. In this embodiment, the slot 36 is located at the proximal end of the head 34 of the bone plate 8. As shown in FIG. 18, the slot 36 is configured to engage the reference wire 5. 7 and 8, the slot 36 may be angled with respect to the surface of the shaft portion 33 of the bone plate 8.

  As shown by FIGS. 16 and 17, the positioning device 7 and the bone plate 8 align the slot 26 of the positioning device 7 with the slot 36 of the bone plate 8 when the positioning device 7 is mounted on the bone plate 8. Are adapted to each other. Accordingly, the through hole 21 of the positioning device 7 is aligned with the proximal through hole 31 of the bone plate 8. The bone plate 8 may further include a screw hole 37 extending through the head 34 from the surface 39 to the surface 38 for receiving the screw 28 of the positioning device 7, so that the positioning device 7 is in the bone plate 8. Can be linked.

  Prior to positioning the bone plate 8, the reference wire 5 is inserted into the bone 1 using the wire insertion instrument 4, and then the bone plate 8 is inserted through the slot 36 through the slot 36, as shown in FIG. The use of the wire insertion instrument 4 and the use of the positioning instrument 7 with the slot 26 and the bone plate 8 with the slot 36 can be moved to a position along the bone 1 with respect to the bone plate 8. Easy to attach to the bone 1.

  In order to determine the depth of the bone anchor hole formed in the bone 1, a meter 44 may be provided, as represented in FIG. The meter 44 can be fastened to a drill sleeve that can be inserted, for example, through the sleeve 6 or through the protective sleeve 11. When the drill bit 42 is moved into the final drilling position in the bone 1, the instrument 44 can be connected so that the instrument 44 can be connected to the drill sleeve without separating the drilling tool 43 from the drill sleeve. It may be formed as a flexible ruler or measuring instrument. In particular, because the instrument 44 is flexible, it can be bent away from the longitudinal axis of the drill sleeve, allowing the instrument 44 to be coupled to the drill sleeve without having to remove the drilling tool 43. To do. Thus, the instrument 44 can be used to measure the length of the screw inserted into the drill hole without disengaging the drilling tool 43. The instrument 44 includes a scale along the instrument to indicate the length of the screw inserted into the drill hole.

  While exemplary embodiments have been described with respect to a proximal femur, it will be understood that the principles of the present invention can also be applied to bone plates for other bones. For example, the present invention can also be provided for a distal femur, tibia, or other long bone. It will be appreciated that the shape and dimensions of the bone plate and wire insertion instrument, if included, the shape and dimensions of the positioning instrument and aiming instrument can be adapted according to the application case without compromising the principles of the present invention. Will.

  It will be apparent to those skilled in the art that various modifications and variations can be made to the structure and method of the present invention without departing from the spirit or scope of the invention. Accordingly, the present invention is intended to embrace modifications and variations of this invention provided they come within the scope of the appended claims and their equivalents.

Embodiment
(1) A method of attaching the bone plate (8) to the bone (1),
Placing the wire insertion instrument (4) such that the first surface (14) of the wire insertion instrument (4) contacts the bone (1);
The wire insertion instrument (4) from the first surface (14) of the wire insertion instrument (4) to a second surface (15) of the wire insertion instrument (4) opposite the first surface (14). 4) inserting a reference wire (5) through an opening (16) of the wire insertion instrument (4) extending through 4);
Removing the wire insertion instrument (4) from the reference wire (5) inserted into the bone (1);
Positioning said bone plate (8) on said bone (1) having a slot (36) open towards a side edge (35) of said bone plate (8), said slot (36) Extends from the first bone-facing surface (39) of the bone plate (8) to the second surface (38) of the bone plate (8) opposite the first surface (39). The slot (36) is transverse to the longitudinal direction of the reference wire (5) so that the reference wire (5) engages the slot (36) of the bone plate (8) Positioning the bone plate (8) by advancing it to the reference wire (5).
(2) Before the step of positioning the bone plate (8), the method includes the step of mounting a positioning device (7) on the bone plate (8), and the step of positioning the bone plate (8) Embodiment 2. The method according to embodiment 1, performed by the positioning device (7) implemented in (8).
(3) The bone plate (8) has a surface structure on the second surface (39) of the bone plate (8), and the positioning device (7) is the surface structure (38 of the bone plate (8). And has a surface structure complementary to
Prior to the step of mounting the positioning device (7) on the bone plate (8), placing the surface structure of the positioning device (7) in contact with the surface structure of the bone plate (8). The method of embodiment 2, comprising.
(4) the positioning device (7) has a slot (26) that opens toward one side of the positioning device (7);
Mounting the positioning device (7) to the bone plate (8) aligns the slot (26) of the positioning device (7) with the slot (36) of the bone plate (8);
4. Method according to embodiment 2 or 3, wherein the reference wire (5) engages the slot (26) of the positioning device (7) in the step of positioning the bone plate (8).
(5) A sleeve (6) having a first axial passage (41) and a second axial passage (40) parallel to the first axial passage (41) is connected to the positioning device (7). ) And a through-hole (21) that contacts the slot (26) and extends through the positioning device (7), the sleeve (6) 5. The method according to any of embodiments 2 to 4, comprising the step of said first axial passageway (41) of) being guided through said reference wire (5).

6. The embodiment of claim 5, comprising inserting at least one tool (12) for drilling the bone (1) through the second axial passage (40) of the sleeve (6). the method of.
(7) Through the second axial passage (40) of the sleeve (6), through the through hole (21) of the positioning device (7) and through the through hole (31) of the bone plate (8). Embodiment 7. The method according to embodiment 5 or 6, comprising the step of inserting a bone anchor into the bone (1).
(8) The longitudinal axis of the second axial passage (40) of the sleeve (6) when a drilling tool (42, 43) is inserted into the second axial passage (40). Embodiment 8. A method according to any of embodiments 5 to 7, wherein a flexible measuring device (44) that bends away from is fastened to the sleeve (6).
(9) A sighting device (10) configured to guide at least one drill sleeve (11) for targeting and drilling into the bone (1) is provided with the positioning device (7). Embodiment 9. The method in any one of embodiment 2-8 including the process mounted in.
(10) including a step of inserting an orientation wire (3) into the bone (1) before the step of placing the wire insertion device (4) in contact with the bone (1); The reference wire (5) inserted by (4) is placed in a plane parallel to the plane on which the orientation wire (3) previously inserted in the bone (1) is placed 10. The method according to any of embodiments 1-9, wherein the wire insertion instrument (4) is placed in contact with the bone (1).

(11) A wire insertion device (4),
A first side (14) having a surface configured to be placed against the bone (1) in a defined manner and a second side (15) opposite the first side (14) ) Having a base (12),
Passing through the base (12) from the first side (14) to the second side (15), receiving the reference wire (5) and guiding the reference wire (5) in a defined direction An opening (16) configured with a length;
A wire insertion instrument comprising a handle or leg (13) extending away from the second side (15).
(12) The wire insertion instrument according to embodiment 11, wherein a handle connecting part (17) capable of fastening the hand grip (9) is formed on the handle or the leg part (13).
13. The wire insertion according to embodiment 11 or 12, wherein the surface configured to be placed against the bone (1) in a defined manner has at least one mandrel (18) protruding from the surface. Instruments.
(14) the surface configured to be placed against bone (1) in a defined manner is configured to be placed against a human proximal femur in a defined manner; The wire insertion instrument according to any one of Embodiments 11 to 13.
(15) a bone fixation kit,
A first side (14) having a surface configured to be placed against the bone (1) in a defined manner and a second side (15) opposite the first side (14) ) Through the base (12) from the first side (14) to the second side (15), receiving a reference wire (5) in a defined direction A handle or leg (13) having an opening (16) configured with a length to guide the reference wire (5) and extending away from the second side (15) A wire insertion device (4), preferably a wire insertion device (4) according to any of embodiments 12-14;
A bone plate (8) comprising a first bone-facing surface (39) and a second surface (38) opposite the first surface (39); and the bone plate (8) A slot (36) open toward the side edge (35), said slot extending from said first surface (38) of said bone plate (8) to said second of said bone plate (8). A bone plate (8) extending to the surface (39);
A positioning device (7), a first surface (24) configured to be placed against the bone plate (8) in a defined manner, and opposite the first surface (24) A base (22) with a second surface (25) on the side, said base (22) having a slot (26) open towards the side edge of said positioning device (7), said slot A bone anchoring kit comprising: a positioning instrument (7) extending from the first surface (24) of the positioning instrument (7) to the second surface (25) of the positioning instrument (7). .

(16) including a reference wire (5), the slot (26) of the positioning device (7) and the slot (36) of the bone plate (8), the positioning device (7) being the bone plate (8) 16. The bone fixation kit according to embodiment 15, wherein the bone fixation kit is configured to align with each other when mounted on and to engage the reference wire (5).
(17) including a sleeve (6) having a first axial passage (41) and a second axial passage (40) parallel to the first axial passage (41), the sleeve (6 ) Through the slot (26) of the positioning device (7) and the slot (26) of the positioning device (7) and through the base (22) of the positioning device (7) The bone fixation kit according to embodiment 15 or 16, wherein the bone fixation kit is configured to be received in (21).
(18) The length of the drill sleeve (6; 11) when the tool (42,43), which is fastened to the drill sleeve (6; 11) and drilled, is inserted into the drill sleeve (6; 11). 18. A bone fixation kit according to any of embodiments 15-17, comprising a flexible meter (44) configured to bend away from the directional axis.
(19) including a sighting device (10) for drilling and drilling into the bone (1), the sighting device (10) comprising: a first surface; and the first surface; At least one through hole having an opposite second surface and configured to receive a drill sleeve (11) from the first surface of the aiming instrument to the second surface of the aiming instrument Extending through a sighting device (10), the sighting device (10) can be mounted on the positioning device (7) and is positioned relative to the bone plate (8) by the positioning device (7). A bone fixation kit according to any of embodiments 15-18, wherein

Claims (9)

A wire insertion device (4) comprising:
A first side (14) having a surface configured to be placed against the bone (1) in a defined manner and a second side (15) opposite the first side (14) ) Having a base (12),
Passing through the base (12) from the first side (14) to the second side (15), receiving the reference wire (5) and guiding the reference wire (5) in a defined direction An opening (16) configured with a length;
A wire insertion instrument comprising a handle or leg (13) extending away from the second side (15).   The wire insertion device according to claim 1, wherein a handle connecting part (17) to which a hand grip (9) can be fastened is formed on the handle or leg (13).   Wire insertion device according to claim 1 or 2, wherein the surface configured to be placed against the bone (1) in a defined manner has at least one mandrel (18) protruding from the surface.   The surface configured to be placed against a bone (1) in a defined manner is configured to be placed against a proximal human femur in a defined manner. The wire insertion instrument as described in any one of -3. A bone fixation kit,
A first side (14) having a surface configured to be placed against the bone (1) in a defined manner and a second side (15) opposite the first side (14) ) Through the base (12) from the first side (14) to the second side (15), receiving a reference wire (5) in a defined direction A handle or leg (13) having an opening (16) configured with a length to guide the reference wire (5) and extending away from the second side (15) A wire insertion instrument (4), preferably a wire insertion instrument (4) according to any one of claims 2 to 4, and
A bone plate (8) comprising a first bone-facing surface (39) and a second surface (38) opposite the first surface (39); and the bone plate (8) A slot (36) open toward the side edge (35), said slot extending from said first surface (38) of said bone plate (8) to said second of said bone plate (8). A bone plate (8) extending to the surface (39);
A positioning device (7), a first surface (24) configured to be placed against the bone plate (8) in a defined manner, and opposite the first surface (24) A base (22) with a second surface (25) on the side, said base (22) having a slot (26) open towards the side edge of said positioning device (7), said slot A bone anchoring kit comprising: a positioning instrument (7) extending from the first surface (24) of the positioning instrument (7) to the second surface (25) of the positioning instrument (7). .   The slot (26) of the positioning device (7) and the slot (36) of the bone plate (8) including a reference wire (5) are mounted on the bone plate (8) by the positioning device (7). The bone fixation kit according to claim 5, configured to align with each other when engaged and to engage the reference wire (5).   A sleeve (6) having a first axial passage (41) and a second axial passage (40) parallel to the first axial passage (41), the sleeve (6) comprising: The slot (26) of the positioning device (7) and a through hole (21) that contacts the slot (26) of the positioning device (7) and penetrates the base (22) of the positioning device (7) The bone fixation kit according to claim 5 or 6, wherein the bone fixation kit is configured to be received by the   When the tool (42, 43), which is fastened to the drill sleeve (6; 11) and drilled, is inserted into the drill sleeve (6; 11), it is removed from the longitudinal axis of the drill sleeve (6; 11). A bone fixation kit according to any one of claims 5 to 7, comprising a flexible measuring device (44) configured to bend away.   A sighting device (10) for drilling and drilling into the bone (1), the sighting device (10) being a first surface and opposite the first surface At least one through-hole having a second surface and configured to receive a drill sleeve (11) from the first surface of the aiming instrument to the second surface of the aiming instrument ( 10) extends through and the sighting device (10) can be mounted on the positioning device (7) and can be positioned relative to the bone plate (8) by the positioning device (7). The bone fixation kit as described in any one of Claims 5-8 which exists.

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